Tubeless Anaesthesia for Microlaryngeal Surgery

Abstract

An anaesthetic technique for laryngeal microsurgery is described and evaluated using intravenous propofol infusion and topical lignocaine with the patient breathing spontaneously without an endotracheal tube. Eighty adult patients divided into two groups according to their ASA status (Group A; 58 ASA I and Il; Group B; 22 ASA III and IV) were analysed. Operating conditions were good in all but one case. Good anaesthesia was achieved in about 70% of patients. The requirement for propofol was less in Group B. Blood pressures decreased signifcantly following induction (P < 0.001) but returned towards the preoperative values after ten minutes in Group A patients whereas the recovery was slower in Group B. Apnoea occurred on induction in about 40% of patients overall. P aeo2 showed a similar small increase in both groups. Oxygenation was adequate. The results show that propofol as an infusion in this simple tubeless technique is satisfactory. As the technique was considered potentially hazardous in those patients with upper airway obstruction, such patients were not included in this study.

Safe tubeless anaesthesia for laryngeal surgery in a patient with a known difficult airway

“…The technique is now widely used in anaesthesia for ear, nose and throat surgery in order to facilitate an unimpeded view of the larynx, and maintain oxygenation and ventilation. However, the most published series of its use have excluded patients with an anticipated or known difficult airway, due to increased risk associated with the technique in these patients [2,3]. We found no published case reports describing the use of tubeless anaesthesia in a patient with a known difficult airway.…”

A tubeless anaesthetic technique for paediatric laryngeal laser surgery

“…Hodges and Lloyd-Thomas [2] used the same technique in a single case of an obstructive vocal cord lesion with a cut down tracheal tube, Aun et al [7] used a nasopharyngeal tube with intravenous anaesthesia in adults, both authors found the technique to be safe. Other authors have described a similar technique with a ventilating laryngoscope or bronchoscope in children [1,8,9], this however, has the disadvantage of possible loss of oxygenation as the endoscope is manipulated.…”

A modified technique of tubeless anaesthesia for microlaryngoscopy and bronchoscopy in young children with stridor

“…( 7) found that propofol provided more stable anaesthesia and better recovery. Other studies using propofol in combination with other agents have also been reported in upper airway surgery (8, 9, 3).…”

“…The dosage of propofol was maintained at the rate of 12 mg·kg –1 ·h –1 throughout the procedure for most of the cases. Aun and colleages ( 3) used propofol with the initial infusion rate of 12 mg·kg –1 ·h –1 and after 10 min the dosage was subsequently reduced. In our study 12 children coughed during bronchoscopy probably due to the local anaesthetic not reaching the whole length of the proximal tracheobronchial tree.…”